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NPI Code Detail

MEDICARE: TRANSITIONS-MENTAL HEALTH ASSOCIATION

MEDICARE: TRANSITIONS-MENTAL HEALTH ASSOCIATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251X00000XSupports Brokerage Agency
3320800000XMental Illness Community Based Residential Treatment Facility405801098CA
4101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1720133721
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRANSITIONS-MENTAL HEALTH ASSOCIATION
Provider Business Mailing Address
First Line : PO BOX 15408
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93406-5408
Country : US
Telephone Number : 805-540-6500
Fax Number : 805-540-6501
Provider Business Practice Location Address
First Line : 784 HIGH ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-5243
Country : US
Telephone Number : 805-540-6500
Fax Number : 805-540-6501
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. JILL BOLSTER-WHITE
Credential :
Telephone Number : 805-540-6500
Provider Enumeration Date : 01/23/2007
Last Update Date : 08/05/2010

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Directions to “TRANSITIONS-MENTAL HEALTH ASSOCIATION ” Practice Location

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